Provider Demographics
NPI:1710486980
Name:LEE, KENDRA TAYLOR
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:TAYLOR
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4702
Mailing Address - Country:US
Mailing Address - Phone:360-734-9555
Mailing Address - Fax:
Practice Address - Street 1:1756 IOWA ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-4702
Practice Address - Country:US
Practice Address - Phone:360-734-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist